Tissue damage, such as tissue separations, lacerations, open wounds, and punctures, arise from a variety of causes. Tissue separation may result from surgical procedures, for example, whereas open wounds may result from traumatic injury. Further, different types of wounds often require unique types of treatment depending on the progression of wound healing. For example, the goal with acute tissue damage treatment may be to control bleeding, whereas long term wound care may be aimed at reducing scarring, eliminating the potential of hematoma, seroma, and “dead-space” formation, as well as managing pain.
A variety of dressings and bandages, along with numerous techniques for applying dressings and bandages, are used to treat tissue damage. One technique for treating open wounds is the tie-over technique. In animals, for example, the tie-over technique involves placement of multiple suture loops in the skin around a wound. A bite of skin is taken with the suture needle. The suture is tied in a knot near the skin. A loop is formed above the knot, and two more knots are tied to maintain the loop's size and shape. With a traditional tie-over bandage, lacing material is threaded through the suture loops in a crisscross fashion, tightened over a bandage or dressing, and tied in place. The lacing material is cut when the bandage is to be changed, and the suture loops are reused for subsequent bandage or dressing placement.
In humans, skin sutures are placed to secure skin grafts over a wound and are used to hold a tie-over bandage. Essentially, the stitches are placed between the graft and the skin edge on each side of the graft and are left long and tied together over a bandage. This means that the sutures are constantly being pulled where the skin and graft are trying to heal together, thus inhibiting healing. Also, the sutures may be difficult to reuse when needed, i.e., for reuse they must be tied in a bow or some other fashion over the top of the dressing and then untied to change the dressing. This is challenging, particularly with normal sized skin sutures.
Placement of the suture loops is time consuming and usually requires anesthesia. Formation of the suture loops can also be challenging because the suture used to make the loops is usually stiff and does not hold knots well. If the knots slip, the loops shrink and loops disappear, eliminating their usefulness for lace placement. If more pliable suture is used to make the loops, the loops flatten out, making lace placement difficult. Tie-over bandages also inhibit freedom of motion, thus causing patient non-compliance. A dog, for example, may scratch or pull at a bandage that is overly limiting and irritating or may get increased limb swelling from lack of motion.
Previous studies have shown that application of tension with a tie-over bandage recruits up to 30% more skin within a 72 hour period. Yet suture loops may not tolerate the amounts of tension needed and can break or stretch out. Systems for skin stretching have been developed from adhesive anchors that secure to elastic tape by hook-and-loop-type connections (such as Velcro) or to lacing materials by incorporated hooks. In dogs and cats, hair growth, desquamation, and skin oils interfere with adhesion of these anchors, and super glue may need to be applied to keep them attached. Removal of the adhesive anchors can cause trauma to the underlying skin. Also, the amount of tension that can be applied to the skin is limited by how well and how long the anchor pads stick and how well the elastic band-anchor connection or lacing-anchor connection can resist the upward and outward forces of the underlying dressing and any patient motion. Other designs (e.g., Sure Close, Wise Band, Silver Bullet, S.T.A.R. Device, Dermaclose) are bulky, do not incorporate bandages, or are not meant for irregularly shaped wounds, thick skin, or active patients.
A need thus exists for devices, systems, and methods for treating tissue damage that solves these and other problems associated with securing objects, such as bandages and other medical devices, to a subject's tissue. More particularly, a need exists for devices, systems, and methods that facilitate the convenient and rapid closure of wounds and that allow rapid placement of bandages, such as tie-over bandages, during wound treatment. A need also exists for providing a secure anchor to a subject's tissue that is independent of tissue thickness or type or presence of hair, oils, or moisture. A need also exists for an easy and convenient means for securing objects to the tissue of a subject, such as the skin, that does not require sutures.